Overview

This study is a multicenter, single-arm, prospective phase II clinical trial that evaluates the efficacy and safety of an intensive conditioning regimen with thiotepa combined with busulfan, fludarabine, and cytarabine for allogeneic hematopoietic stem cell transplantation in the treatment of myeloid malignancies with extramedullary involvement. The conditioning regimen includes thiotepa at a dose of 5mg/kg/d at d -7 (1 day), fludarabine at 30mg/m2/d from d -6 to d -2 (5 days), cytarabine at 1g/m2/d from d -6 to d -2 (5 days), and busulfan at 3.2mg/kg/d from d -4 to d -3 (2 days). Conditioning begins on day -7, and donor hematopoietic stem cell infusion is performed on day 0. All patients will undergo bone marrow examination on day 14 and day 28 post-transplant, followed by bone marrow examinations every 30 days within the first year after transplantation, and every 60 days within the second year after transplantation. If disease relapse is suspected during the follow-up period, bone marrow or extramedullary relapse site examinations will be conducted at any time. The primary study endpoints are the 1-year and 2-year progression-free survival (PFS) rates post-transplant. Secondary study endpoints include the incidence of acute graft-versus-host disease (GVHD) within 180 days post-transplant, cumulative relapse rates at 1 year and 2 years post-transplant, 1-year and 2-year overall survival (OS), graft-versus-host disease-free, relapse-free survival (GRFS), non-relapse mortality (NRM), cumulative incidence of chronic GVHD, and the incidence of Cytomegalovirus （CMV）and Epstein-Barr virus（EBV）reactivation within 1 year.

Eligibility

Inclusion Criteria:

1. Age between 18 and less than 70 years, regardless of gender
2. Peripheral T-cell lymphoma (PTCL) was diagnosed according to the 2016 WHO criteria and met any of the following criteria:
   1. High risk: IPI score ≥ 3 or aaIPI score ≥ 2 ( aaIPI is suitable for patients younger than 60 years old).
   2. Patients who achieved CR or PR after first-line chemotherapy (PET-CT or CT examination was performed according to the patient 's economic conditions）

3.Patients must have a suitable hematopoietic stem cell donor:

1. Related donors must have at least 5/10 matches for HLA-A, -B, -C, -DQB1, and - DRB1.
2. Unrelated donors must have at least 8/10 matches for HLA-A, -B, -C, -DQB1, and -DRB1.

   4.Hematopoietic cell transplantation comorbidity index (HCT-CI) score ≤ 2.

   5.ECOG (Eastern Cooperative Oncology Group) performance status: 0-2.

   6.Adequate liver, kidney, and cardiopulmonary function, meeting the following

   requirements

        a.Serum creatinine ≤ 1.5x ULN (the upper limit of normal). b.Cardiac function: Ejection
        fraction ≥ 50%. c.Baseline oxygen saturation > 92%. d.Total bilirubin ≤ 2.0 x ULN; ALT and
        AST ≤ 2.0 x ULN，AKP ≤ 2.0 x ULN e.Pulmonary function: DLCO (corrected for hemoglobin) ≥ 40%
        and FEV1 (Forced Expiratory Volume in 1 second) ≥ 50%.
        7.Patients must have the ability to understand and be willing to participate in this study
        and sign an informed consent form.
        Exclusion Criteria:
          1. PTCL patients did not meet the criteria of high-risk.
          2. PTCL ALK + patients with CR after first-line treatment.
          3. History of malignancies other than lymphoid tumors within the 5 years prior to
             screening, except for adequately treated in situ cervical cancer, basal cell
             carcinoma, squamous cell carcinoma of the skin, and curatively treated localized
             prostate cancer or ductal carcinoma in situ
          4. ECOG ≥ 3.
          5. HCT-CI score ≥ 3.
          6. Any unstable systemic diseases, including but not limited to unstable angina, recent
             cerebrovascular accidents or transient ischemic attacks within the 3 months prior to
             screening, myocardial infarction within the 3 months prior to screening, congestive
             heart failure (New York Heart Association [NYHA] class ≥ III), severe arrhythmias
             requiring drug treatment after pacemaker implantation, significant liver, kidney, or
             metabolic diseases, and pulmonary arterial hypertension.
          7. Active, uncontrolled infections, including those associated with hemodynamic
             instability, new or worsening infection symptoms or signs, new infectious lesions on
             imaging, or persistent unexplained fever without signs or symptoms of infection.
          8. HIV-infected individuals.
          9. Active hepatitis B (HBV) or active hepatitis C (HCV) requiring antiviral therapy.
             Patients at risk of HBV reactivation, are defined as those who are positive for
             hepatitis B surface antigen or core antibody without receiving antiviral therapy.
         10. History of autoimmune diseases
         11. Pregnant or breastfeeding women.
         12. Fertile males and females unwilling to use contraception during the treatment period
             and for 12 months after treatment.